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APPLI�ATf�..�l FOR CONSTRUC'. �ON PEfRiiiA1T <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, 1NA 98201 •259-8810 <br /> � <br /> 11 DEMOLITION f l COMBINATION I I BUILDING �l MECHANICAL f'�PLUMBING I� SIGN <br /> PROJECTADDRESS 1�� I �1����� ���r�� C��� ) <br /> J <br /> O�� �� ��MAILApOR������ CITV 21P {+110NE - <br /> ARCHITECT OR�ESIGNEF MAIL ADDRESS CITY ZIP PHO!lE <br /> GECEPALCONTRACTOR MAILAD�RE55 CITV ZIP PHONE STATEIJCENSEx <br /> MECHANICALCONTR4CTOR MAILAUORESS CITY ZIP p110NE STATELICENSEM <br /> PLUMBINGCONTRACiOR MAILADDRE55 CITY ZIP PHONE STAiEUCENSEx <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: I l GAS ❑ ELECTRIC fl <br /> OESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON FND PHONE NO. <br /> u�x6► � <br /> S�� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUIL�ING APPLICATION AND KNOW Tl1E SAME TO 6E TNUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEANING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�lDESCHIPTIONOFPROPERTY(SHON'NOELOWORFTfACHTYJOCOPIES) NOT. THE GRANTING 0,= A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK _Of AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY T'� PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> PARCELTA%I.D.NUMBER CONTRACTORS LAIN 1827 RCW AND 296200 WAC. <br /> CONSTFUCTION LOFN LEN�ER RDDRESS.TEIEPMONE NUMBER X <br /> SIGII�TUR[ pATE <br /> CITY BUSINE55 LICENSE t10. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATEH CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. i <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> i <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> 1 KITCHEN SINK 8 DISP ; CLOTHES ORYERS � <br /> DISHWASHER i VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ' <br /> CLOTHES WASHEfi � WqTER HEATER � <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) i � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS " ' GAS FIREPLACE ' <br /> � � <br /> SINK (SERVICE—BAR, ETC.) � GAS RANGE � <br /> ; GAS PIPING � <br /> i' �- i EXHAUST FAN i <br /> � � <br /> i i <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> � <br /> PERMIT S a(J � L� PERMIT 5 i <br /> TOTALFEE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIOE SETBACK PIAN CHECy(NUMOER �✓ FEE RECEIPT NO. <br /> �7�OSS0 <br /> usezoN� LOTAREA vacnnrsire FEES VALUATION FEE <br /> nres ❑ No ow�oiNc I <br /> � <br /> HEIGHT LIMITATION NO.OF�V/ELLING SIZE OF OL�G/CI. � <br /> I/NITS P�UM�ING i <br /> OCGUPANCY NO OFSTOPIE$ OCCUPANTLOAD BASEMENT MECNANICFL i <br /> 3ii0UP <br /> f7 YES Il NO <br /> FlRE ALARM REO'0 REASON ADDITIONFL PLAN CHECK ; <br /> pTHGR i <br /> FIRESPRINKLERREO'D REASON i <br /> STAiE OUIL�ING SURCHFfiGE j <br /> TYPEOFCONST PfANSAPPRpyE00Y CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES , <br /> onrE TAX CODE IS 3105 TOTAL ; <br /> K: <br />